| NPI | 1649602228 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: SC 10126) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 7025) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: KY 7025) | |
| Enumeration Date | 2013-08-06 |
| Last Update Date | 2025-04-28 |